Community Based Occupational Therapy for people with dementia (COTiD) and their caregiver: evidence for applicability in Italy

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1 Community Based Occupational Therapy for people with dementia (COTiD) and their caregiver: evidence for applicability in Italy Andrea Fabbo Cognitive Disorders and Dementia Unit, Local Health Autorithy and Services, Modena, Italy

2 Occupational Therapy for PWD and their caregiver at home

3 Occupational Therapy for PWD and their caregiver at home occupational therapy can improve daily functioning of people with mild to moderate dementia and may reduce the burden of the caregiver Positive effects are still present at a 12-weeks follow up which can justify the application of this intervention This program of occupational therapy for people with dementia, which are living at home, shown to be cost-effective compared to usual care. Graff MJ et al.bmj Dec 9;333(7580):1196. Graff MJ et al. BMJ Jan 19;336(7636):134-8.

4 The COTid Programme WHO? People with dementia and their caregiver living at home WHAT? 10 session of occupational therapy HOW? Both PWD and caregiver ; partecipation togheter is needed WHEN? Mild to moderate dementia (MMSE range: 10-24), clients and motivated caregiver WHY? An evidence -based programme, client-centered,flexible, tailored, cost- effective, rigid methodology in order to: 1. promote the partecipation of PWD in significative daily activities in an ecological environment ; 2. encourage the coping of CG with consequences of dementia and related disabilities; 3. maintain PWD retained capacities ; 4 improve quality of life in PWD and caregiver.

5 RCT results: Graff et al. PWD N=96 Caregiver N=96 Better quality of life (SF 12 / QoL-AD) Better quality of life (SF 12 / QoL-AD) Improvement of mood ( GDS-30) Improvement of mood (CES-D) Better performances in ADL Stress reduction (Zarit Burden Assessment) Better health perception (COPM) Better sense of competence (Sense of Competence Questionnaire)

6 PHASE A 1. The story of PWD: OPHI 2.The story of Caregiver: Etnographic interview 3. The story of OT: skills observation 1. Assessing person with dementia by OPHI-II 2. Assessing caregiver Ethnographic Interview by 3. Observing an activity 4. Shared goals 5. Developing the treatment PHASE B Goal Setting PHASE C Treatment

7 How? Teaching the client how to act in the most functional way in daily activity by Effective compensatory strategies Adjustment in physical (house) and social environment

8 How? Emotional, supporting and technical training of the caregivers Problem Solving Teaching of communication techniques and making people aware of their use of effective strategies How to adapt home environment How to cope with caregiving burden

9 Translation of the book Erghotherapie bij ouderen met dementie en hun mantelzorgers (M. Graff et al 2010) in italian (financed by Alzheimer Caregiver's Association ASDAM) in collaboration with Italian Society of Occupational Therapy- SITO 2013 begin project in Italy 1 Master course for Occupational Therapists and OT students of Modena and Reggio Emilia University Specific course focused on dementia and service network of Health Authority of Modena Sharing of the project in Mirandola (MO)

10 Modena, The 1th Mastercourse Cotid, prof. M.Graff, september march 2014

11 4 th Master Course, Turin - Italy COTID-It 2 nd Master Course, Brescia, Italy rd Master Course, Rome- Italy th edition, January 2016

12 Feasibility study in Italy Caregiver's family association Design study Geriatrician and GP's Primary care Hospital COTiD Memory Clinic of Mirandola Memory Clinic of Cremona

13 Feasibility study in Italy Objective To determine the applicability in the Italian country of community based occupational therapy on occupational performance and satisfaction of people with dementia (PWD) and the sense of competence of their care givers (CG). Andrea Fabbo, Lucia Bergamini, Petra Bevilacqua, Rabih Chattat*, Glenda Garzetta, Alessandro Lanzoni, Elena Lucchi**, Alessandro Morandi**, Christian Pozzi**, Maud Graff*** Cognitive Disorders and Dementia Unit, Local Health Authority and Services of Modena University of Modena and Reggio Emilia, Modena- Italy *Department of Psychology, Alma Mater Studiorum University of Bologna; **Teresa Camplani Foudation, Ancelle della Carità, Cremona, Italy and SUPSI- Svizzera ; ***Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands and

14 Feasibility study in Italy 27 dyads PWD ( mild to moderate dementia) living in the community and their CG (primary care givers) Main outcome measures level of performance and satisfaction during the participation in significant activities perceived by people with dementia assessed with Canadian Occupational Performance Measure (COPM). Care giver burden assessed with the Sense of Competence Questionnaire (SCQ). Participants were evaluated at baseline (T0) and at the end of the treatment (T1),

15 Preliminary results Mean age PWD 80.6 (47-91) Mean age caregiver (CG) 57.7 (22-84) N= 27 p value COPM (canadian occupational performance measure) - Level of perceived performance - Level of satisfaction performace 4,6 +/- 1,4 5,1 +/- 1,8 6,7 +/- 1,6 7,0 +/- 1,7 < 0,001 < 0,001 SCQ (sense of competence questionnaire) 77,2 +/- 13,3 82,6 +/- 12,6.005 In press

16 Preliminary results There are no changes in cognitive status (MMSE), neuropsychiatric symptoms (NPI, GDS), QoL and health status (SF-12) of PWD. Neither for caregiver (CG) were found evidence of significant variations in domains of quality of life (QoL- AD), global health (SF- 12, GHQ), depression (CES-D) or burden (Zarit interview). In literature have been described changes in QoL parameters and caregiver stress at 3 months follow-up. In press

17 Conclusions -1 COTiD programme is applicable in Italy and results are promising for implementation at a national level and compatible with scientific evidence in literature. Further studies ar needed to: - increase the number of cases who completed the programme; - explore effects on follow-up In press

18 Conclusions -2 Survey : barriers and facilitators to implement the Cotid programme in Italy In press

19 For more informations: @AndreaFabbo